Recognizing Eating Disorders in Patients

• Eating disorders are a deadly mental illness and something that healthcare providers often miss. 
• There are several types of eating disorders, all expressed as different signs and symptoms. 
• As healthcare providers, we often must read between the lines and pick up on queues in order to appropriately identify a possible diagnosis. Read on for more insight on how to spot eating disorders in patients to help them achieve the resources they need. 

If we work in a hospital, we often know what our patients are there for, what disease process they have, and how to help them. When there is an additional problem, we identify it.

However, there is a deadly killer that we as healthcare providers consistently miss: Eating disorders. 

I am here as a nurse, but also as a sufferer and fighter against eating disorders. I have had one type or another since I was 11 years old. I have gone to eating disorder treatment centers before, and my experiences and those of the women and men around me have shaped my knowledge.  

I have been able to spot eating disorders where other healthcare professionals have not. I attribute this to my experiences. And I feel like it is my duty to share it with you.

Types of Eating Disorders

First things first. There are a wide number of eating disorders, from little known PICA, where people crave and eat inanimate objects, to the more known Anorexia Nervosa and Bulimia Nervosa.  

Since the DSM V was released, there is also the new classification of Binge Eating Disorder, known as BED. However, there are also other eating disorders known as OSFED.  

Unless your life has been affected by it, I doubt you have heard of it. It contains subgroups of eating disorders that do not fall under the Big Three- Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. 

For example, someone who has lost a lot of weight, fears food, limits their food intake, but is not emaciated or “underweight”, would be classified as having OSFED, particularly Atypical Anorexia.  

Another example of OSFED, would be someone who may binge on food and purge, but does not do so the number of times a week to classify as full Bulimia Nervosa. They too, will have a deep fear of food and have shame around their bodies.

OSFED is actually the deadliest eating disorder- even surpassing Anorexia Nervosa. Why? Because it is underdiagnosed, and not taken seriously until things get so bad, and their bodies are irreparably damaged. 

Populations Affected by Eating Disorders

We think of the typical person with an eating disorder to be a young, extremely thin, female who doesn’t eat. However, less than 6% of people with eating disorders are medically diagnosed as “underweight.

Men

About 10% of those seeking treatment for eating disorders are men compared with about 90% of women. We do not actually know how many men have eating disorders because it is stigmatized as a “female” disease.  

Transgender or Nonbinary

Another population that is missed when it comes to eating disorders are those who identify as transgender or nonbinary. This often is the result of trauma related to feeling as though they are in the wrong body and wanting to align with another gender.  

Imagine yourself, a young female that identifies as a boy. Would you want to go through the experience of puberty and getting breasts? I know I wouldn’t. So, they often restrict, or binge and purge, fast, over exercise, etc in order to be more in alignment with their preferred gender. 

Type-1 Diabetics

Yet another population you probably don’t know as potential eating disorder patients, are those with type 1 diabetics. You will see these same patients over and over again, and yet an eating disorder diagnosis will elude them. These patients are said to have Diabulimia, they may binge and purge, limit food intake, or both.  

People with diabulimia, choose not to give themselves insulin, because they have learned if they do not, they will lose weight. However, they often suffer from chronic health problems because of this and risk their lives. It’s not a diagnosis in the DSM V, but it is recognized and treated in eating disorder treatment centers.

Treatment For Eating Disorders

All these individuals deserve treatment for their eating disorders. Treatment, however, is a privilege, one that many do not have. I heard at one point, only 1 in 10 pts are able to seek out treatment. It is costly and timely. But don’t they deserve a chance? A chance for help and happiness?

If we can identify these patients, hopefully, case management can get involved and try to help. Many individuals are adults, and therefore, have the right to refuse help. It’s not that they want to be ill. But the thought of what one must give up in order to attain that is often terrifying and overwhelming.

In time though, they may change their minds. With children, parents must be notified. It would be a good idea to tell the doctor of your concerns, and once again seek out case management. From there it is the parents’ decision as to what to do. 

Eating disorders are shrouded with shame, so many patients will not tell you they have eating disorders unless they are actively in treatment. Many will come in with problems not related to their eating disorders, but if you watch and listen, you will see it’s there.

Examples of Signs Exhibited by Those With Eating Disorders

For example, a patient may have difficulty swallowing, but refuse applesauce for their pills. I once had a patient prescribed a medicine that needed to be in orange juice, and she was going to refuse. She wanted to take it in water. The doctor said “absolutely not”. I talked to the patient, listened and learned she had been struggling with an eating disorder for years. She was afraid of those 50 calories in that orange juice.  After showing compassion, she eventually took the medicine, and said it was nasty. She probably would have gotten sick if she had tried to take it in water. 

If you see a repeat diabetic ketoacidosis patient, I would be highly suspicious of an eating disorder. Additionally, if a patient is really picky with their meals, won’t eat, or will only drink certain protein supplements instead of a meal (and they aren’t suffering from swallowing problems), suspect an eating disorder.  

Vomiting without complaints of nausea are also a good indicator. And if they go to the bathroom shortly after a meal, and insist you leave, they could be purging. 

The Bottom Line

These are just some of the nuances I have experienced. In your practice, you may see different things. The important thing is to be aware. These are often invisible illnesses, but they can kill. The sooner someone gets help, the better. 

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